Responsibilities of a Night Shift Med Surg Nurse vs. Day Shift Med Surg Nurse

by | Apr 19, 2023 | Med-Surg | 2 comments

Nursing is a very demanding and dynamic profession, and nurses have to be adept at handling their responsibilities. Nurses who work in medical-surgical units have to provide quality care and handle a range of patients with various medical conditions. However, the responsibilities of a day shift med surg nurse and night shift med surg nurse differ slightly. Let’s discuss very practical specifics.

night shift med surg nurse day vs night

If you’re considering moving from nights to days on a med-surg unit, this post is for you!

Day Shift Nurse Med Surg Responsibilities

During day shift, there are more medications to administer throughout the shift, and the goal is to progress the patient in their plan of care. Day shift nurses work with therapy, order changes, tests, and physician visits, where the doctor reviews the patient’s vitals and makes plans for the day.

Med surg nurses who work day shift also have to handle more visitors and answer numerous questions. Interdisciplinary rounds, and most test and procedures occur during the day. If patients require a CT scan, MRI, catheterization, or surgery, it is the responsibility of the day shift nurse to facilitate these procedures and ensure that the patients return safely.

Day shift nurses also have to monitor patients’ meals and administer time-sensitive medications related to meals, such as insulin. Day shift nurses are also responsible for facilitating admissions and discharges since most admissions happen during the day. Discharge planning is also a vital responsibility of the day shift nurse.


Summary of Day Shift Med Surg Nurse Responsibilities

  • Give meds and implement medication order changes; a higher volume of this occurs during day shift
  • Know goals of care and move forward
    • Example 1: If physician orders patient to be in the chair for meals and walk twice, the day shift nurse needs to ensure that happens
    • Example 2: If patient needs to transition from IV to oral pain meds, the day shift nurse typically educates and prepares the patient for that transition
    • Example 3: If the patient needs a PICC line placed to be able to be discharged with at home antibiotics, the day shift nurse will coordinate getting that line placed, the correct orders for home care, and setting up the consult.
  • Speak with visitors, update family as appropriate
  • Coordinate with physical, occupational, and/or speech therapy, social work, case management, and any other discipline seeing the patient because they all work during business hours and not at night
  • Coordinate non-urgent (and sometimes urgent/emergent!) diagnostics like MRIs, CTs, and more, as scheduled and routine scans are done during business hours
  • Ensure meals are provided as ordered under guidelines provided by physician and preferences from patient, documenting appropriately for intake and output
  • Give time-sensitive meds with meals (like insulin)
  • Facilitate most discharges, transfers, and admissions
  • Keep patients awake and active to maintain appropriate sleep hygiene

Pros and Cons of Day Shift

The biggest pro of working day shift is simply always being awake during the day and asleep at night. This is good for your health, as you’re not messing with your sleep cycle at all. Also, if you enjoy interacting with more people and seeing patients progress and get to leave, day shift is for you. You also don’t get bored or sleepy because you’re always on the go, and all of the coffee shops, local restaurants, and hospital cafeteria are open during the day.

The major con of day shift is that there is simply a lot more to do. You will be constantly busy and addressing needs. It does not get slow or quiet on days shift, which gets exhausting. Finally, you’ll be dealing with many more admissions, transfers, and discharges as they tend to mostly occur on day shift. While night shift nurses have these occurrences, it’s not typical to have multiple admissions, transfers, or discharges in one shift.

Night Shift Nurse Responsibilities

Night shift nursing is focuses on letting the patient rest and gear up for the next day. The goal is to ensure that the patient gets adequate rest. Night shift nurses have to provide medications, monitor patients, and handle emergencies that may arise. They may have to check blood sugar levels at bedtime and 0300, but insulin is not often scheduled at that time because a meal is not being provided.

Night shift nurses have to handle fewer visitors and manage fewer questions. They also facilitate fewer tests and procedures. Additionally, they do not handle as many admissions and discharges as day shift nurses.

Night shift nurses also have unique challenges since not everyone is available, and they have to talk to an on-call provider who may be asleep. Finally, nurses cannot make quick clarifications or calls to the physician. They have to ensure that they do not continually wake up physicians or other medical professionals.

Summary of Night Shift Med Surg Nurse Responsibilities

  • Promote rest
  • Give medications and perform necessary procedures, but clustered to minimize awakenings
  • Monitor for decompensation; work with available staff and resources to address any urgent or emergent situation

Do Night Shift Nurses Make More Money?

The pay difference between night shift and day shift nurses can vary depending on the institution, location, and other factors. However, in general, night shift nurses may receive a higher hourly rate than day shift nurses due to the increased responsibilities and potential for more challenging patient cases during the night shift. Additionally, some institutions may offer a shift differential pay, which is an extra amount paid to employees who work during non-traditional hours. This differential pay can vary but typically ranges from 10% to 15% of the base hourly rate.

Pros and Cons of Night Shift

The biggest pros are that night shift is much quieter with fewer people. This is really helpful for new nurses as they learn the ropes and are not constantly bombarded by questions or changes. You also are doing less physical labor because most patients don’t all need multiple walks, help getting up to the chair, and want to be bathed. These things are almost always done on day shift making it so there are far fewer tasks to complete. The pay is also great!

The biggest con is how it messed with your sleep. This impacts your personal life and even your health. And while there are fewer actual tasks, it doesn’t mean night shift is always easy. You’re dealing with on-call physicians and you’ll have to deal with situations with far fewer resources. You don’t have case management, social work, PT, OT, ST, administration, or all of the doctors at your disposal!

Final Thoughts for Med Surg Nurses

Nurses play an essential role in providing quality care to patients, and they must handle their responsibilities adeptly. The difference between day shift and night shift nursing care is structured differently, and nurses must adapt to each shift’s unique challenges. Day shift nurses handle more visitors, tests, and procedures, and their focus is on progressing the patient in their plan of care. Night shift nurses are responsible for letting the patient rest, providing medications, and handling emergencies that may arise with limited resources.

Some people work on nights for decades and absolutely love it, while others cannot work overnight shifts for more than a few years – and there’s no shame in that. I personally worked nights for eight months and couldn’t wait to get to day shift (even though the shifts were busier). I had some colleagues who worked nights for 10, 20, and even 30 years! To each his own. Pick what works best for you!

More Resources for Med Surg Nurses

Are you a new Med-Surg nurse?

MSM Video

Med-Surg Mindset from FreshRN is the ultimate resource for nurses new to this complex and dynamic acute care nursing specialty. Whether you are fresh out of nursing school or an experienced nurse starting out in med-surg for the first time, the learning curve is steep. With input from three experienced bedside nurses, this comprehensive course is all you need to learn all of the unspoken and must-know information to become a safe, confident, and successful medical-surgical nurse.

Picture of Kati Kleber, founder of FRESHRN

Hi, I’m Kati.

Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

Connect with her on YouTube, Pinterest, TikTok, Instagram, and Facebook, and sign-up for her free email newsletter for new nurses.


  1. Yvonne

    Last line: ” Some people work on nights for dea”…
    Curious to know how that’s supposed to end! 🙂


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